Bastianon Martina, Esposito Davide, Melani Caterina, Bosisio Enrica, Savio Andrea Sebastiano, Pratesi Giovanni
Department of Surgical and Integrated Diagnostic Sciences, University of Genoa, Genoa, Italy.
Clinic of Vascular and Endovascular Surgery, IRCCS Ospedale Policlinico San Martino, Genova, Italy.
J Vasc Surg Cases Innov Tech. 2025 Jul 16;11(6):101927. doi: 10.1016/j.jvscit.2025.101927. eCollection 2025 Dec.
Urgent repair of complex aortic aneurysms not amenable to standard endovascular aneurysm repair is technically challenging and limited by existing technology. Physician-modified endografts are associated with challenges such as time-consuming preparation, the need for graft constraint, and the risk of misalignment-particularly in angulated aortas. In situ fenestration, although a valuable alternative, carries the risk of visceral ischemia. We present the case of a 78-year-old patient with a symptomatic pararenal abdominal aortic aneurysm treated by the combined modalities of a physician-modified endograft and in situ fenestration to overcome these challenges.
对于无法采用标准血管腔内动脉瘤修复术治疗的复杂主动脉瘤进行紧急修复，在技术上具有挑战性，且受现有技术限制。医生改良的血管内移植物存在诸多挑战，如准备工作耗时、需要对移植物进行约束以及存在错位风险，尤其是在成角主动脉中。原位开窗术虽然是一种有价值的替代方法，但存在内脏缺血风险。我们报告了一例78岁有症状的肾旁腹主动脉瘤患者，通过医生改良血管内移植物和原位开窗术联合方式治疗，以克服这些挑战。
